Aortoiliac embolism is an acute occlusive event affecting the aortoiliac segment, requiring prompt intervention to restore perfusion to the affected limb. Rapid, structured management is essential to prevent irreversible ischaemic injury.
Revascularisation is the cornerstone of management. Both surgical and catheter-based options are available, and the choice between them depends on the clinical picture. The full protocol specifies which approach to use and under what conditions — only a partial outline is provided here.
The primary benchmark is angiographic improvement of the treated limb within 6–12 hours. If improvement is not evident within this window, the protocol defines the appropriate change in strategy.
DOI: 10.1016/j.ejvs.2019.09.006
For patients requiring surgical thrombo-embolectomy for acute limb ischaemia, regional or local anaesthesia may be considered, but always with an anaesthetist present.
For patients requiring surgical thrombo-embolectomy for acute limb ischaemia, the use of over the wire embolectomy catheters under fluoroscopic control should be considered.
For patients undergoing open and endovascular surgery for acute limb ischaemia, completion angiography is recommended.
For patients undergoing thrombolysis for acute limb ischaemia, it is recommended that recombinant tissue plasminogen activator or urokinase is used.
For patients with acute limb ischaemia, aspiration and mechanical thrombectomy should be considered.
If there is any sign of deterioration in the condition of the limb, or no improvement on angiography over 6–12 hours, a change in treatment strategy should be considered.
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